Tag: guidelines.

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New guidelines help doctors diagnose heart failure in children – Toronto Star


Toronto Star

New guidelines help doctors diagnose heart failure in children
Toronto Star
A child with shortness of breath, rapid heart rate and some coughing may be suffering not from asthma but from heart failure. That's according to new guidelines aimed at helping frontline doctors recognize pediatric heart failure that were issued …
Children's heart failure may be overlooked in ERCBC.ca
New guidelines help doctors spot potentially deadly heart failure in childrenCalgary Herald
New pediatric heart failure guidelines a first in CanadaMedical Xpress

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Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

Int J Qual Health Care. 2012 Aug 14;

Authors: Licskai C, Sands T, Ong M, Paolatto L, Nicoletti I

Abstract
Quality problemInternational guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets.Initial assessmentRegional pilot data demonstrated a knowledge-to-practice gap.Choice of solutionsWe engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework.ImplementationKnowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient.EvaluationSix guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months.Lessons learnedA knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1.

PMID: 22893665 [PubMed – as supplied by publisher]

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Asthma Foundation comes out in support of Guidelines Group – Scoop.co.nz (press release)

Asthma Foundation comes out in support of Guidelines Group
Scoop.co.nz (press release)
The Asthma Foundation is concerned that lack of funding will mean that the New Zealand guidelines for the diagnosis and treatment of asthma will not be updated. The guidelines were produced by New Zealand Guidelines Group (NZGG) with the help of the …

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Asthma Guidelines Are Not Always Followed – Family Practice News Digital Network


Family Practice News Digital Network

Asthma Guidelines Are Not Always Followed
Family Practice News Digital Network
ORLANDO – The 2007 National Asthma Education and Prevention Program guidelines are viewed as cumbersome and too time-consuming by some primary care pediatricians. That finding, from a 23-question survey sent to 80 pediatricians, suggests that "there is …

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Asthma guidelines implementation: a guide to the translation of GINA guidelines into improved care.

Asthma guidelines implementation: a guide to the translation of GINA guidelines into improved care.

Eur Respir J. 2012 Jan 26;

Authors: Boulet LP, Fitzgerald JM, Levy ML, Cruz AA, Pedersen S, Haahtela T, Bateman ED

Abstract
In 1995 the Global Initiative on Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and country initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socio-economic settings.

PMID: 22282546 [PubMed – as supplied by publisher]

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New Guidelines On Managing Childhood Asthma Released

Children aged five and under – particularly those with intermittent viral-induced wheezing – should be treated with oral corticosteroids for asthma only if their wheeze is severe enough to require hospital admission, according to new guidelines.

The Thoracic Society of Australia and New Zealand (TSANZ) updated its position statement on corticosteroid use in childhood asthma after reviewing recently published clinical research.

The understanding of childhood asthma and recognition of the need for separate management guidelines for children aged five and under has increased since the TSANZ published its previous position statement in 2002, Professor Peter Van Asperen, Head of the Department of Respiratory Medicine at The Children’s Hospital at Westmead said in an editorial published in the latest Medical Journal of Australia.

“If control is not achieved using initial preventer therapy, it is important to review the diagnosis of asthma – particularly in children aged five years or younger – as many children with recurrent cough are mislabelled as having asthma,” Prof Van Asperen said.

“Oral corticosteroids improve outcomes in children presenting to hospital with acute asthma, but the efficacy of oral corticosteroids for children aged five years or younger with acute, mild-moderate, viral-induced wheezing has been questioned.

“In children aged five years or younger (particularly those with intermittent, viral-induced wheezing) the use of oral corticosteroids should be limited to those with severe wheeze who require hospital admission.”

The revised position statement also provides updated recommendations on the roles of inhaled corticosteroids, leukotriene receptor antagonists and combination medications in childhood asthma management. It highlights the role of leukotriene receptor antagonists as an alternative to long-acting beta-agonists as add on therapy in children not adequately controlled on inhaled corticosteroids and also recommends that long-acting beta-agonists not be used in children aged five years or younger.

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[Stocked medications in emergency physician-based medical services in Germany : Reality and requirements according to guidelines.]

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[Stocked medications in emergency physician-based medical services in Germany : Reality and requirements according to guidelines.]

Anaesthesist. 2010 Dec 4;

Authors: Rörtgen D, Schaumberg A, Skorning M, Bergrath S, Beckers SK, Coburn M, Brokmann JC, Fischermann H, Nieveler M, Rossaint R

BACKGROUND: The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses. METHOD: In the period of May 2008 to January 2009 a total of 148 EMDs were contacted and asked to supply drug storage lists for emergency physician-staffed rescue vehicles in their respective jurisdiction. The addresses of all EMDs who could be identified by the federal office of the National Association of Emergency Medical Director, Germany were used over the period. The evaluation was conducted anonymously. The tracer diagnoses “cardiopulmonary resuscitation”, “acute coronary syndrome”, “status generalized tonic-clonic seizure,” “severe asthma attack”, “acute exacerbation of chronic obstructive pulmonary disease”, “supraventricular tachycardia”, “severe brain trauma” and “acute heart failure with signs of hypoperfusion” were selected. Current and established guidelines have been identified with the homepage of the Scientific Medical Societies in Germany and supported by the leading European and International guidelines. RESULTS: The corresponding lists were returned by 95 different emergency service areas (response rate 64.2%). With a total of 39 groups of substances 142 different drugs could be identified, an average of 54±9.6 and median 55 (range 31-77). Listed are agents giving the provision in percent, for which the comparison with guidelines for tracer diagnoses could show deficits: sodium bicarbonate 75.8%, calcium 50.5%, magnesium 45.3%, noradrenaline 65.3%, adenosine 58.9%, dobutamine 57.9%, lorazepam iv 13.7%, salbutamol 41.1%, ipratropium bromide 13.7% (the last two as liquid preparations for inhalation). With a frequency of about 30-80%, depending on the respective tracer diagnosis, no medical emergency treatment according to the highest level of evidence is possible. CONCLUSION: Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.

PMID: 21127828 [PubMed – as supplied by publisher]

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